STM

THE TIME IS NOW. sm Short Term Medical Insurance &

Gap Insurance working together. The Time for Healthcare Coverage is Now. * Group Term Life Insurance Term Group & Critical Illness Benefit Rider Super Gap Plus Plan Includes: STM SUPER PLUS PLAN INCLUDES STM PLAN + SUPER GAP PLUS Individual Short Term Medical Insurance Individual Short Term Group Accident Medical Expense Benefit Group Group Accident Insurance which includes: Group Non-Insurance Benefit Boost Services Include: Group Hospital Fixed Indemnity which includes: Group Group Accidental Death & Dismemberment Benefit Group Retail Prescription Discount Card & Pet RX Discount Card Discount Card Retail Prescription X-Rays & imaging & Daily Outpatient Laboratory Test Benefit X-Rays & imaging Daily Outpatient Laboratory Test & Daily Physician Office Visit Benefit, Daily Outpatient Radiology, Visit Benefit, Daily Outpatient Radiology, & Daily Physician Office Free Vitamins, MeMD (Telehealth 24/7), & MailMyPrescriptions.com MeMD (Telehealth Vitamins, Free Aetna Dental Access Discounts, Identity Theft Protection - LifeLock Aetna Dental Access Discounts, Identity Theft Protection Emergency Room Visit Benefit & Daily Hospital Confinement Room Visit Emergency

SHORT TERM GROUP ACCIDENT CRITICAL ILLNESS DAILY HOSPITAL EMERGENCY PHYSICIAN OFFICE VISIT, GROUP TERM NON-INSURANCE MEDICAL INSURANCE INSURANCE INSURANCE BENEFIT CONFINEMENT ROOM VISIT LABS, IMAGING & X-RAY LIFE INSURANCE* SERVICES BENEFIT BENEFIT & WELLNESS BENEFIT

Short Term Medical Insurance of STM Plan is underwritten by United States Fire Insurance Company. Group Accident Insurance and Group Hospital Fixed Indemnity Insurance of the Super Gap Plus Plan are underwritten by United States Fire Insurance Company. *Group Term Life Insurance of Super Gap Plus Plan is underwritten by Investors Heritage Life Insurance Company and not available in all states. Non-Insurance Benefit Boost Services are provided by Healthy America and United Business Association. ah-2557 *Note: Since STM Super Plus Plan includes an individual Short Term Medical insurance plan and does not require you to join the association or to purchase Super Gap Plus Plan to apply for coverage, if you do not want to join the association or do not want the Super Gap Plus plan, you can purchase the STM Plan in lieu of the STM Super Plus Plan on a stand-alone basis. The Super Gap Plus Plan sold outside of the STM Super Plus Plan also might be available in additional states. The STM Super Plus Plan is a STM SM The Time for Healthcare Coverage is Now. combination of both the STM Plan individual short term medical insurance with the Super Gap Plus Plan into one convenient plan. G

sm INSIDE STM SUPER PLUS PLAN Individual Short Term Medical Insurance PGS 04-21…STM PLAN PGS 06-07…$5,000 Deductible Plan PGS 14-18…Limitations & Exclusions PG 08………Benefit Descriptions PGS 19-21…Additional Information: PG 09………Pre-Certification Requirements (Billing, Effective Dates, Claim Forms) PGS 10-12…Medical Benefits

COVERAGE SHORT TERM MEDICAL INSURANCE BILLING, FULFILLMENT, ENDORSED BY: COVERAGE UNDERWRITTEN BY: & CUSTOMER SERVICE United States Fire Insurance Company PROVIDED BY: Healthy UBA america

Group Association Supplemental Gap Plan PGS 22-63…SUPER GAP PLUS PLAN

PGS 24-27…Group Accident Insurance PGS 34-35…Group Hospital Fixed Indemnity Insurance PGS 28-29…Group Hospital Fixed Indemnity Insurance Daily Emergency Room Visit for Daily Hospital Confinement Benefit Accident & Sickness Benefit PG 30………Group Hospital Fixed Indemnity Insurance PGS 36-41…Group Hospital Fixed Indemnity Insurance Daily Physician Office Visit Benefit Critical Illness Insurance Benefit PG 31………Group Hospital Fixed Indemnity Insurance PGS 42-43…Group Term Life Insurance Daily Outpatient Diagnostic Radiology, PGS 44-49…Limitations & Exclusions X-Ray & Imaging Benefits PGS 50-51…State Availability for STM Super Plus PG 32………Group Hospital Fixed Indemnity Insurance PGS 52-67…Non-Insurance Benefit Boost Services Daily Outpatient Laboratory Test Benefit PGS 68-71…About United Business Association & Other Membership Details

ASSOCIATION BENEFITS GROUP ACCIDENT INSURANCE BILLING, FULFILLMENT, PROVIDED BY: & GROUP HOSPITAL FIXED & CUSTOMER SERVICE INDEMNITY INSURANCE PROVIDED BY: COVERAGE UNDERWRITTEN BY: United States Fire Insurance Company Healthy UBA america

GROUP TERM LIFE INSURANCE COVERAGE UNDERWRITTEN BY: FOR TIMES WITHOUT TRADITIONAL HEALTH INSURANCE BETWEEN OPEN ENROLLMENTS STUDENT NOT ON PARENT PLAN BETWEEN JOBS COBRA TOO EXPENSIVE

THE COVERAGE IS A SHORT TERM MEDICAL INSURANCE POLICY THAT IS NOT INTENDED TO QUALIFY AS THE MINIMUM ESSENTIAL COVERAGE REQUIRED BY THE AFFORDABLE CARE ACT (ACA). UNLESS YOU PURCHASE A PLAN THAT PROVIDES MINIMUM ESSENTIAL COVERAGE IN ACCORDANCE WITH THE ACA, YOU MAY BE SUBJECT TO A FEDERAL TAX PENALTY. ALSO, THE TERMINATION OR LOSS OF THIS POLICY DOES NOT ENTITLE YOU TO A SPECIAL ENROLLMENT PERIOD TO PURCHASE A HEALTH BENEFIT PLAN THAT QUALIFIES AS MINIMUM ESSENTIAL COVERAGE OUTSIDE OF AN OPEN ENROLLMENT PERIOD. NOTE: THE POLICY IS NOT RENEWABLE. NO CONTINUOUS COVERAGE. The policy of insurance provides coverage for short term duration only. It is not renewable. Although this short term plan may be written for new and completed separate Coverage Periods (as long as you meet the eligibility criteria described in the application), coverage does not continue from one policy to another. This means that a new application must be submitted, a new effective date is given, a new preexisting condition exclusion period begins and a new deductible and out- of-pocket expense must be met. Any medical condition which may have occurred and/or existed under a prior policy will be treated as a preexisting condition under the new policy. United States Fire Insurance Company Short Term Medical Insurance provides coverage for unexpected medical bills and other health care expenses. Short Term Medical Insurance can be a great fit for those in-between coverage.

Short Term Medical plans offer medical coverage, are medically underwritten, and do not cover preexisting INSIDE conditions. They do not provide Minimum Essential STM PLAN Coverage as mandated by the Affordable Care Act.

PGS 6-7 $5,000 Deductible Plan

PG 8 Benefit Descriptions

PG 9 Pre-Certification Requirements

PGS 10-12 Medical Benefits

PGS 14-18 Limitations & Exclusions

PG 19-21 Additional Information (Billing, Effective Dates, Claims & Administrator contact info)

Read this guide carefully. This is a brief description of Short Term Medical Insurance and is not an insurance contract, nor part of the insurance policy and is subject to the terms, conditions, limitations, and exclusions of the policy. Coverage may vary or may not be available in all states. You’ll find complete coverage details in the policy. Short Term Medical Insurance is underwritten by United States Fire Insurance Company. The Short Term Medical Policy does not meet Minimum Essential Coverage as mandated by the Affordable Care Act. Short Term, limited duration plans are not subject to certain provisions of federal health care reform, including the provisions related to Essential Health Benefits, lifetime limits, preventive care, guaranteed renewability, and preexisting conditions. The preexisting condition exclusion for Short Term Medical Plans will apply for all insureds, including those under the age of 19. Know your plan. Short Term Medical plans offer medical coverage, are medically underwritten (so you can be declined) and do not provide Minimum Essential Coverage. What does this mean for the applicant? They may have to pay a tax penalty, depending on their income level and the cost of plans available. Examples of the claims Short Term Medical Plans do not cover are for most preventive care, mental health and treatment related to medical conditions they had prior to the plan’s effective date. Because these plans are not guaranteed renewable, the applicant may not be eligible for another short term plan after the plan’s termination date; and the preexisting condition exclusion will apply to any conditions that arose during any prior short term plans. $5,000 Deductible Plan 6 Person andfor ALLbenefits The Coinsurance Deductible, Percentage, Coinsurance Limit, Co-Pays and Policy Period Maximum CoveragePeriod Availability Policy Period Maximum (is afterdeductible,perpersonandcopaysare notincluded) Coinsurance Limit durations onlycover364daysandnot365days. (12 monthoptionisnotavailableinallstates.Also12 PERIOD WAITING (% ofcovered expensesyoupayafterdeductibletoCoinsuranceLimit) Coinsurance Percentage INSURANCE MEDICAL SHORT TERM DEDUCTIBLE

10-12 for additionalcovered services. Policy for state specific variations of medicalbenefits, exclusions and limitations. Term18 ofthisguide. Short Medical Plans donotcover costs associated with preexisting conditions. *Please make sure to read thefullterms, definitions, limitations, and exclusions in your andonpages 14- Policy , unless otherwise stated for aspecificbenefitlisted, unlessotherwise onpages10-12. Effective Date of coverage underthepolicy. or receipt oftreatment, at least72hoursfollowing theCovered Person’s receive that benefitsbegin, for Sicknesses byoccurrence ofsymptoms and/ Date, to Covered theninrespect Sickness, Person willonly beentitled to coverageIf was purchased within3days oftheCovered Person’s Effective not theywere Necessary. Medically or eligiblesuch as expensereasonable limits, and customary or whether or expenses” underthe policy, provisions, to andare allotherpolicy alsosubject To beconsidered for reimbursement, expenses mustqualifyas “eligible Period. a Coverage willberequired Period, Deductible for theremainder nofurther ofthePolicy family perPolicy Period. Once 3familymembershave in mettheirrespective Deductible isperCoveredDeductible Person perCoverage Period. per of3Deductibles Maximum (per personfor ALL Benefits) $5,000 6 or12months

$1,000,000 View Medical on pages Benefits apply to eachCovered $10,000 20% Review your Preexisting Condition Exclusion Preexisting conditions and complications resulting directly from a preexisting condition are excluded from coverage. View State Variations in your Policy for possible variations in your state.

“Preexisting condition” means a disease or physical condition for which medical advice or treatment was recommended or received by the Covered Person during the 12 months prior to the Covered Person’s Effective Date of coverage.

7 SHORT TERM MEDICAL BENEFITS 8 (per PolicyPeriod) Durable MedicalEquipment (per PolicyPeriod) Physiotherapy (not subjecttoDeductible) CareUrgent Center (Coinsurance willnotapply.NotsubjecttoDeductible) Visit Physician Office Person andfor ALLbenefits The Coinsurance Deductible, Percentage, Coinsurance Limit, Co-Pays and Policy Period Maximum Assistant Surgeon admitted asanInpatientforfurthertreatment) Accident, Injury,orSicknessunlesstheCovered Personisdirectly room foruseofemergency (applied tocharges intheeventof RoomBenefit Emergency (See pages10-12forALLMedicalEligibleBenefits&theirdetails) & more Diagnostic Testing, RadiologyandLabs, Pregnancy andChildbirth, Hospital &Surgery (per PolicyPeriod) Home HealthCare Extended Care Facility Local Ambulance (per PolicyPeriod) and Mental&NervousDisorders Alcohol andDrugAbuseExpenseBenefit of medical benefits, exclusions andlimitations. TermShort Medical Plans donotcover costs associated with preexisting conditions. *Please make sure to read thefullterms, definitions, limitations, andexclusions in your andonpages14-18 ofthisguide.Policy

, unless otherwise stated for aspecificbenefitlisted, unlessotherwise below: (inpatient oroutpatient)

View Medical on pages10-12for additional Benefits covered services. , after whichCoinsuranceafter willapply Not to exceed adailyrate of $150 when covered results in Sickness $50 Maximum pervisitday$50 Maximum Not to exceed upto 20%ofthe when related to covered injury charge of the primary surgeon charge oftheprimary Additional $250 Deductible Additional $250Deductible hospitalization asinpatient nor amaximumof60days Review your Policy for state specific variations Maximum of$250pertrip Maximum Maximum of$250pertrip Maximum $50 Co-pay for eachvisit Maximum 1visit perdayMaximum $50 Co-Pay for eachvisit Coinsurance Percentage Outpatient Treatment and Coinsurance Limit Subject to Deductible, Subject Inpatient Treatment Maximum of20visits Maximum Maximum of10visits Maximum

Maximum of 31daysMaximum Maximum of$1,000 Maximum Maximum 40 visits Maximum Sickness: Per Visit Injury apply to eachCovered :

Pre-Certification Requirements

1. All hospitalizations, other Inpatient care, and Surgeries or Surgical Procedures must be Pre-Certified. 2. To comply with the Pre-Certification requirements, the Covered Person must: a. Contact the Company or its agent at the telephone number contained in the Insured’s policy as soon as possible before the expense is to be incurred; and b. Comply with the instructions of the Company and submit any information or documents they require; and c. Notify all Doctors, Hospitals and other providers that this insurance contains Pre-Certification requirements and ask them to fully cooperate with the Company. 3. If the Covered Person complies with Pre-Certification requirements, and the expenses are Pre-Certified, the Company will pay Eligible Expenses subject to all terms, conditions, provisions and exclusions described in this policy. If the Covered Person does not comply with the Pre-Certification requirements or if the expenses are not Pre-Certified: a. Eligible Expenses will be reduced by 50%; and b. The Deductible will be subtracted from the remaining amount; and c. The Coinsurance will be applied. 4. Emergency Pre-Certification: In the event of an emergency Hospital admission, Pre-Certification must be made within 48 hours after the admission, or as soon as is reasonably possible. 5. Pre-Certification Does Not Guarantee Benefits - The fact that expenses are Pre-Certified does not guarantee either payment of benefits or the amount of benefits. Eligibility for and payment of benefits are subject to all the terms, conditions, provisions and exclusions herein. 6. Concurrent Review - For Inpatient stays of any kind, the Company will Pre-Certify a limited number of days of confinement. Additional days of Inpatient confinement may later by Pre-Certified if a Covered Person received prior approval. 9 Medical Expense Benefits

Short Term Medical Insurance Description of Medical Expense Benefits Subject to the Deductible, Co-pay, Coinsurance, Benefit Maximums and other limits set forth in the SCHEDULE OF BENEFITS, the Company will pay Eligible Expense benefits incurred while this insurance is in effect.

Medical Eligible Expense Benefits are only payable: 1. for Usual, Reasonable and Customary Charges incurred after the Deductible has been met; 2. for those Medically Necessary Eligible Expenses incurred by or on behalf of the Covered Person.

No benefits will be paid for any expenses incurred that are in excess of Usual, Reasonable and Customary charges.

Eligible Expenses Include.

1. Charges made by a Hospital for: a. Daily room and board and nursing services not to exceed the average semi- private room rate; b. Daily room and board and nursing services in Intensive Care Unit (Charges for Intensive Care Unit (ICU) not to exceed 3 times the average semi-private room rate; c. Use of operating, treatment or recovery room; d. Services and supplies which are routinely provided by the Hospital to persons for use while patients; e. Emergency treatment of an Injury, even if Hospital confinement is not required; f. Prescription drugs administered while hospital confined; and g. Emergency treatment of a Sickness or Injury; however, an additional $250 Deductible will apply to emergency room charges unless the Covered Person is directly admitted to the Hospital as an Inpatient for further treatment of that Sickness or Injury. 2. For Surgery at an Outpatient surgical facility, including services and supplies. 3. Charges for Physician Office Visits, for Physician visit charge only. All other services received are subject to remaining policy limits including Deductible, Co-Pay, Coinsurance, Benefit Maximums and other limits set forth in the SCHEDULE OF BENEFITS. 4. For charges made by a Physician for professional services other than an office visit, including Surgery. 5. Charges for an assistant surgeon are covered up to 20% of the Usual, Reasonable and Customary charge of the primary surgeon. (Standby availability will not be deemed to be a professional service and therefore is not covered). 6. We will pay for charges for anesthetics and their administration by a Physician in connection with a Surgical Procedure, if a Covered Person requires the services of an anesthetist for general anesthesia services. 7. For pregnancy and childbirth benefits for normal deliveries and cesarean sections for the Insured Person or the Insured Person’s Spouse. Routine nursery care of a newborn child are available so long as the child qualifies as an Eligible Dependent as defined. Benefits will cover a period of hospitalization for maternity for: a. a minimum of 48 hours of inpatient care following a vaginal delivery; or b. a minimum of 96 hours of inpatient care following delivery by cesarean section. The length of stay may be shortened at the direction of the attending Physician after conferring with the mother.

10 Medical Expense Benefits(cont’d.)

8. For dressings, sutures, casts or other supplies which are Medically Necessary and administered by or under the supervision of a Physician, but excluding nebulizers, oxygen tanks, diabetic supplies, other supplies for use or application at home, and all devices or supplies for repeat use at home, except Durable Medical Equipment as herein defined. 9. For diagnostic testing using radiology, ultrasonographic or laboratory services (psychometric, intelligence, behavioral and educational testing are not included). 10. For basic functional artificial limbs, eyes or larynx, or breast prosthesis but not the replacement or repair thereof. 11. For reconstructive surgery when the surgery is directly related to surgery which is covered under this policy, including reconstructive breast surgery and prosthetic devices incident to a Mastectomy. Coverage will also be extended to include surgery on a non-diseased breast to establish symmetry with the diseased breast and prosthesis and physical complications of mastectomy, including lymphedemas. As used in this benefit: “Mastectomy” means the surgical removal of all or part of a breast as a result of breast cancer. “Reconstructive breast surgery” means surgery performed as a result of a mastectomy to reestablish symmetry between the two breasts and includes augmentation mammoplasty, reductive mammoplasty, and mastopexy. 12. For radiation therapy or treatment and chemotherapy. 13. For hemodialysis and the charges by the Hospital for processing and administration of blood or blood components but not the cost of the actual blood or blood components. 14. For oxygen and other gasses and their administration by or under the supervision of a Physician. 15. Extended Care Facility charges for room and board accommodations; if: a. The Covered Person is an Inpatient in that facility on the certification of the attending Physician that the confinement is Medically Necessary; b. The confinement commences immediately following a period of at least three (3) continuous days of Hospital confinement; and c. That confinement is for the same covered Injury or Sickness that was treated during the Covered Person’s confinement in the Hospital. 16. Treatment of a Covered Person by a Home Health Care Agency under a Home Health Care Plan. Up to four (4) consecutive hours in a twenty-four (24) hour period of Home Health Care services shall be considered as one Home Health Care visit. Eligible Expenses for Home Health Care are the Maximum Allowable Charges made for the following: a. Part-time skilled nursing care; b. Physical Therapy; c. Speech Therapy; d. Medical supplies, drugs and medicines prescribed by a Physician;

11 Medical Expense Benefits(cont’d.)

e. Laboratory services by or on behalf of the Hospital but only to the extent benefits for those services would have been paid under this policy had the Insured Person remained hospitalized; f. Occupational therapy; and g. Respiratory therapy. However, benefits will not be paid for charges made by a Home Health Care Agency for: a. Any charges excluded under the Exclusions of the Policy; b. Full-time nursing care at home; c. Meals delivered to the home; d. Homemaker services; e. Any services of an individual who ordinarily resides in the Insured’s home or is a member of the Insured’s immediate family; or f. Any transportation services. Benefits for Home Health Care are in lieu of any similar benefits provided under any other provision of the policy. 17. Local Ambulance transport necessarily incurred in connection with Injury, and Local Ambulance transport necessarily incurred in connection with Sickness resulting in Inpatient hospitalization. 18. Dental treatment and dental surgery necessary to restore or replace Sound Natural Teeth lost or damaged as a result of an Injury covered under this policy. 19. Medically Necessary rental of Durable Medical Equipment as defined herein, up to the purchase prices, not including expenses for customization and only for the portion of the cost equivalent to the Coverage Period. 20. Physiotherapy if prescribed by a Physician who is not affiliated with the Physiotherapy practice, necessarily incurred to continue recovery from a covered Injury or Sickness. We will pay the benefit shown in the Schedule of Benefits for the covered Eligible Expenses incurred for physiotherapy as an outpatient, up to the Maximum Benefit Amount shown on the Schedule of Benefits for the Outpatient Physiotherapy benefit. Charges include treatment and office visits connected with such treatment when prescribed by a Physician including diathermy, ultrasonic, whirlpool, heat treatments, microtherm, spinal adjustments, manipulation, acupuncture, massage or any form of physical therapy. Total treatment per Injury or Sickness will not exceed the Maximum Benefit Amounts for Physiotherapy shown in the Schedule of Benefits.

12 13 IMPORTANT LIMITATIONS & EXCLUSIONS

14 Limitations & Exclusions Short Term Medical Insurance THE PLAN PROVIDES LIMITED BENEFITS. This is only a general outline of the coverage provisions and exclusions. It is not an insurance contract, nor part of the insurance policy. You will find complete coverage details in the policy. General Exclusion: The Policy does not cover any loss resulting in whole or part from, or contributed to by, or as a natural or probable consequence of any of the following even if the immediate cause of the loss is an Accidental bodily Injury, unless otherwise covered under this Policy by Additional Benefits:

1. Treatment, services or supplies which are not Medically Necessary. 2. Treatment, services or supplies which are not prescribed by a Physician as necessary to treat an Injury or Sickness. 3. Consultations and/or treatment provided over the Internet. 4. Treatment, services or supplies which are determined to be Experimental / Investigational in nature. 5. Treatment, services or supplies which are received without charge or legal obligation to pay, except Medicaid. 6. Treatment, services or supplies which would not routinely be paid in the absence of insurance. 7. Services provided normally without charge by the Policyholder. 8. Dental treatment except as stated in the DESCRIPTION OF MEDICAL EXPENSE BENEFITS section of this Policy. 9. Hearing examinations or hearing aids. 10. Injury or Sickness due to war or any act of war, whether declared or undeclared, or service in the armed forces of any country. 11. Injury or Sickness due to actively participating in a riot or civil disorder, or to which a contributing cause was the Covered Person’s commission or of attempt to commit a felony or to which a contributing cause was the Covered Person’s being engaged in an illegal occupation. 12. Injury or Sickness due to suicide or intentionally self-inflicted injury while sane or insane. 13. While participating in any intercollegiate sport, intramural sport, club sport, professional sport, contest or competition; traveling to or from such sport, contest or competition, or, while participating in any practice or conditioning program for such sport, contest, or competition. 14. Treatment in any Veterans Administration or federal Hospital, except if there is a legal obligation to pay. 15. Any loss sustained or contracted in consequence of the Covered Person’s being intoxicated or under the influence of any narcotic, unless administered on the advice of a Physician. 16. Elective surgery and elective treatment. 17. Prescription Drugs dispensed or purchased while not Hospital Confined. 18. Expenses covered under any occupational benefit plan, Workers Compensation Act, Occupational Disease Law or Act, or similar law. 19. Any care or treatment outside of the United States. 20. Any Injury requiring treatment which arises out of, or in the course of fighting, brawling, assault or battery. 21. Services or treatment rendered by a Physician, Nurse or any other person who is employed or retained by the Covered Person; or an Immediate Family Member of the Covered Person. 22. Injury resulting from a motor vechicle Accident to the extent that Benefits are payable under any automobile medical exepnse insurance or automobile no-fault plans. 23. Sickness, Injury or treatment or medical condition arising out of hang gliding, skydiving, glider flying, parasailing, sail plan, bungee jumping, racing or speed contests, scuba diving, or parachuting; snowmobiling, skiing, surfing, or roller skating. 24. Correction of congenital defects, except as it relates to a newborn or newborn adopted child added as a Covered Person. 25. Personal hygiene/convenience items, telephone, missed appointments, or completion of claim forms. 26. Expenses for telephone consultations. 27. Expense covered by any other valid and collectible medical, health or Accident insurance.

15 Limitations & Exclusions (cont’d.) Short Term Medical Insurance THE PLAN PROVIDES LIMITED BENEFITS. This is only a general outline of the coverage provisions and exclusions. It is not an insurance contract, nor part of the insurance policy. You will find complete coverage details in the policy. General Exclusion: The Policy does not cover any loss resulting in whole or part from, or contributed to by, or as a natural or probable consequence of any of the following even if the immediate cause of the loss is an Accidental bodily Injury, unless otherwise covered under this Policy by Additional Benefits: 28. Expenses incurred in connection with family planning, the enhancement of fertility, fertility tests, correction of infertility, in vitro fertilization, artificial insemination, fertility medication and services or supplies for inducing conception. 29. Expenses incurred in connection with a voluntary sterilization or any sterilization reversal process, tubal ligation, vasectomy. 30. Expense incurred for breast implants or breast reduction. 31. Expenses for non-prescription birth control. 32. The cost of any drug, including birth control pills, supply, treatment or procedure that prevents conception or childbirth. 33. Expense incurred for any service, treatment, or supply for the diagnosis or treatment of sexual dysfunction (including erectile dysfunction). This includes, but is not limited to: drugs, laboratory and x-ray tests, counseling, penile prostheses necessary due to any medical condition or organic disease (a penile prosthesis will be eligible for payment only after prostate surgery); impotence (organic or otherwise). 34. Expense incurred for Transsexual procedures; sexual reassignment surgery. 35. Expense incurred for Adult circumcision. 36. Marriage, Family and Group Counseling. 37. Expense incurred for eye examinations or prescriptions, eyeglasses and contact lenses (except for sclera shells which are intended for use of corneal bandages), eye refractions, multiphasic testing, lasix or other vision procedures. 38. Treatment for cataracts. 39. Expenses incurred for allergy testing and allergy treatment. 40. Treatment provided in a governmental Hospital unless there is a legal obligation to pay such charges in the absence of insurance. 41. Expense incurred for noncystic acne, topical acne treatments, non-malignant moles, non-malignant warts or lesions. 42. Expenses incurred for submucus resection and/or other surgical correction for a deviated nasal septum. 43. Expenses incurred for treatment of learning disabilities or disorders or Attention Deficit Disorder. 44. Voluntary or elective abortion. 45. Expense incurred for: vitamins or food supplements; or drugs to promote or stimulate hair growth. 46. Expenses incurred for replacement braces and appliances, except for repair or replacement that is required by a changed condition due to Sickness or Injury. 47. Massage Therapy or Acupuncture/Acupressure Services, unless otherwise specifically allowed for in the Physiotherapy Benefit. 48. Services rendered for detection and correction by manual or mechanical means (including x-rays incidental thereto) of structural imbalance, distortion or subluxation in the human body for purposes of removing nerve interference where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column. 49. Expenses incurred for services or supplies for the diagnosis and treatment of sleep disorders, including but not limited to apnea monitoring and sleep studies. 50. Any treatment, service or supply not specifically covered by this Policy.

16 Limitations & Exclusions (cont’d.) Short Term Medical Insurance THE PLAN PROVIDES LIMITED BENEFITS. This is only a general outline of the coverage provisions and exclusions. It is not an insurance contract, nor part of the insurance policy. You will find complete coverage details in the policy. General Exclusion: The Policy does not cover any loss resulting in whole or part from, or contributed to by, or as a natural or probable consequence of any of the following even if the immediate cause of the loss is an Accidental bodily Injury, unless otherwise covered under this Policy by Additional Benefits:

51. Addiction and Codependency - services and supplies related to: (a) caffeine addiction and non-chemical addictions such as gambling, sexual, spending, shopping, working and religious, and (b) treatment for codependency. 52. Weight modification or surgical treatment of obesity, including but not limited to wiring of the teeth and all forms of intestinal bypass surgery. 53. Venereal disease, including all sexually transmitted diseases and conditions. 54. Immunizations and Routine Physical Exams. 55. Hypnotherapy when used to treat conditions that are not recognized as Mental or Nervous Disorders by the American Psychiatric Association, and biofeedback, and non- medical self-care or self-help programs. 56. Any services or supplies in connection with cigarette smoking cessation. 57. Exercise programs, whether or not prescribed or recommended by a Doctor. 58. The costs of services or supplies of a common household use, such as exercise cycles, air or water purifiers, air conditioners, allergenic mattresses, and blood pressure kits. 59. Charges for travel or accommodations, except as expressly provided for local ambulance. 60. Treatment incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s). 61. Expenses to treat complications resulting from treatment or conditions which are not covered. 62. Cosmetic procedures, except cosmetic surgery required to correct an Injury for which benefits are otherwise payable under this Policy or for newborn or adopted children; hirsutism; Gynecomastia; Sclerotherapy for veins of the extremities. 63. Organ transplants. 64. Kidney or end stage renal disease. 65. Rest cures or custodial care services and supplies related to custodial care such as care provided in rest homes, health resorts, homes for the aged, halfway houses, or places mainly for domiciliary or custodial care. 66. Services or supplies for foot care including flat foot conditions, supportive devices for the foot, the treatment of subluxations of the foot, care of corns, bunions (except capsular or bone surgery), calluses, toenails, fallen arches, weak feet, chronic foot strain and symptomatic complaints of the feet. 67. Hernia and Sports Hernia, regardless of how caused. 68. Skeletal irregularities of one or both jaws, including orthognathia and mandibular retrognathia; temporomandibular joint dysfunction. 69. The cost of dental treatment or care or orthodontia or other treatment involving the teeth or supporting structures, except as specifically covered. 70. Treatment, medication or hormones to stimulate growth, or treatment of learning disorders, disabilities, developmental delays or deficiencies, including therapy. 71. Travel in or upon, alighting to or from, or working on or around any motorcycle or recreational vehicle including but not limited to: two- or three-wheeled motor vehicle; four-wheeled all-terrain vehicle (ATV); jet ski; ski cycle; or riding in a rodeo according to the Policy provisions; or any off-road motorized vehicle not requiring licensing as a motor vehicle. 72. Total or partial hysterectomy, unless it is Medically Necessary due to a diagnosis of carcinoma. 73. Tonsillectomy or Adenoidectomy.

17 Limitations & Exclusions (cont’d.) Short Term Medical Insurance THE PLAN PROVIDES LIMITED BENEFITS. This is only a general outline of the coverage provisions and exclusions. It is not an insurance contract, nor part of the insurance policy. You will find complete coverage details in the policy. General Exclusion: The Policy does not cover any loss resulting in whole or part from, or contributed to by, or as a natural or probable consequence of any of the following even if the immediate cause of the loss is an Accidental bodily Injury, unless otherwise covered under this Policy by Additional Benefits:

1. Chronic fatigue or pain disorders, Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC), or related immunodeficiency disorders. 2. Injury or Sickness incurred during travel or flight in or on any vehicle for aerial navigation, including boarding or alighting from: a. While riding as a passenger in any aircraft not intended for the transportation of passengers; or b. While being used for any test or experimental purpose; or c. While piloting, operating, learning to operate or serving as a member of the crew thereof; or d. While traveling in any such aircraft or device which is owned or leased by or on behalf of the Policyholder of any subsidiary or affiliate of the Policyholder, or by the Covered Person or any member of his household. Except as a fare paying passenger on a regularly scheduled commercial airline or as a passenger in a non- scheduled, private aircraft used for business or pleasure purposes. 3. Pre-existing conditions, as defined in the Policy, are excluded. This exclusion does not apply to a newborn child or newborn adopted child who is added to coverage under this Policy in accordance with ELIGIBILITY FOR INSURANCE.

STM Plan is available in: STM Plan is available in:

6 Month Plan Duration 12 Month Plan Duration 6 Month Plan Duration 12 Month Plan Duration Available State Available State (185 days) (364 days) (185 days) (364 days) Alabama ✓ ✓ ✓ South Carolina ✓ Only available for Arizona ✓ 11 months not 12 months Arkansas ✓ ✓ Texas ✓ ✓ Georgia ✓ ✓ West Virginia ✓ ✓ Iowa ✓ ✓ Wisconsin ✓ ✓ Kansas ✓ ✓ Wyoming ✓ Kentucky ✓ ✓ ✓ Duration is available in this state Michigan ✓ Duration is not available in this state Mississippi ✓ ✓ IMPORTANT NOTE ABOUT STATE AVAILABILITY: Nebraska ✓ ✓ In Kansas & Nevada, the STM Plan is sold stand-alone only. There is not an option to add the Super Gap Plus Plan in this Nevada ✓ state. North Carolina ✓ ✓ 18 Administrative Services are administered by: Healthy America - 866.438.4274

EFFECTIVE DATES BILLING INFORMATION

This Short Term Medical Plan is only available The Short Term Medical Plan drafts for recurring to be issued with an effective date starting payments on the 1st of every month (if 1st effective on the 1st or 15th of the month. date) and on the 15th of every month (if 15th effective date). Initial premium is due at time of application and will be processed upon approval and issue of your application. All billing is done on a monthly bank draft or monthly credit card.

Important Note: You must meet the eligibility requirements in order to become insured, which may include medical underwriting. There is no coverage until you are informed in writing that your application has been processed and approved. 19 See any provider or specialist for covered expenses.

FOR SHORT TERM MEDICAL INSURANCE CLAIMS ASSISTANCE

HSR 4100 Medical Parkway Carrollton, TX 75007 Phone: 1.866.523.3452 Fax: 1.972.512.5824 For a claim form, go to: ubamembers.com/claimforms.html

Claims for benefits shall be administered based on the Policy. Benefits are subject to the definitions, limitations, exclusions and other provisions within the Policy. For more information and complete details of the terms, conditions, limitations, definitions and exclusions of coverage, please refer to the Policy.

20 Billing, Fulfillment & Customer Service Provided by: Healthy America Insurance Agency, Inc. 409 W Vickery Blvd Fort Worth, TX 76104 Phone: 1.866.438.4274 Fax: 1.817.335.1270 Email: [email protected] Healthy Website: ubamembers.com america

21 HELP OFFSET DEDUCTIBLES COINSURANCE OUT-OF-NETWORK PROVIDER COSTS DUE TO ACCIDENTS & INJURIES ER/URGENT CARE VISITS & FIRST DIAGNOSIS OF CRITICAL ILLNESS PHYSICIAN VISIT, LABS & X-RAYS & WELLNESS

ASSOCIATION BENEFITS GROUP ACCIDENT INSURANCE BILLING, FULFILLMENT, PROVIDED BY: & GROUP HOSPITAL FIXED & CUSTOMER SERVICE INDEMNITY INSURANCE PROVIDED BY: COVERAGE UNDERWRITTEN BY: United States Fire Insurance Company Healthy UBA america

GROUP TERM LIFE INSURANCE COVERAGE UNDERWRITTEN BY: The Super Gap Plus Plansm is valuable coverage for families, people who tend to be accident-prone or with a family history of cancer, heart attack, stroke, or those that want that extra layer of protection for some of their out-of-pocket costs due to an accident, being diagnosed with a critical illness, emergency room & urgent care visits or for doctor visits, labs & x-rays. Super Gap Plus Plansm is designed to help supplement your comprehensive health insurance plan for additional protection. INSIDE SUPER GAP PLUS PLAN

PGS 24-27 Group Accident Insurance PGS 28-29 Group Hospital Fixed Indemnity Insurance Daily Hospital Confinement Benefit PG 30 Group Hospital Fixed Indemnity Insurance Daily Physician Office Visit Benefit PG 31 Group Hospital Fixed Indemnity Insurance Daily Outpatient Diagnostic Radiology, X-Ray & Imaging Benefits PG 32 Group Hospital Fixed Indemnity Insurance Daily Outpatient Laboratory Test Benefit PGS 33-34 Group Hospital Fixed Indemnity Insurance Daily Emergency Room Visit for Accident & Sickness Benefit PGS 36-41 Group Hospital Fixed Indemnity Insurance Critical Illness Insurance Benefit Rider PGS 42-43 Group Term Life Insurance PGS 44-49 Exclusions & Limitations PG 50 State Availability for Super Gap Plus Plan PGS 52-67 Non-Insurance Benefit Boost Services PGS 68-71 About United Business Association & other Membership Details

THE INSURANCE PORTIONS OF THIS PLAN PROVIDE LIMITED COVERAGE. THEY DO NOT PROVIDE COMPREHENSIVE MAJOR MEDICAL INSURANCE. THIS IS A GROUP ACCIDENT & HOSPITAL FIXED INDEMNITY INSURANCE & GROUP TERM LIFE INSURANCE ONLY POLICY. Read this guide carefully. This is a brief description of various group association insurance products and is not an insurance contract, nor part of the Certificate of Insurance and is subject to the terms, conditions, limitations, and exclusions of the Group Policy and Certificate(s) of Insurance. Coverage may vary or may not be available in all states. You’ll find complete coverage details in the Certificate(s) of Insurance. Group Accident Insurance and Group Hospital Fixed Indemnity Insurance is underwritten by United States Fire Insurance Company, Eatontown, NJ. The insurance described in this document provides limited benefits. Limited benefit plans are insurance products with reduced benefits intended to help supplement comprehensive health insurance plans. The insurance coverage is not an alternative to comprehensive coverage. It does not provide major medical or comprehensive medical coverage and is not designed to replace major medical insurance. Further, the insurance coverage is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act. Covered Critical Illnesses are subject to the definitions, limitations and exclusions of the Group Policy and Certificate Rider.Coverage for Critical Illness is for Member and eligible Spouse between the ages of 18-64. Benefit for Group Critical Illness Insurance ends at age 65. Benefits are paid at 10% of the Benefit Maximum if first diagnosis occurs in the first year from the effective date.Group Term Life Insurance is underwritten by Investors Heritage Life Insurance Company and covers member and eligible spouse only and coverage ends at age 65. United Business Association, Crum & Forster, United States Fire Insurance Company, Investors Heritage Life Insurance Company and Healthy America are separate legal entities and have sole financial responsibility for their own products. GROUP ACCIDENT INSURANCE 24 Loss of Speech&Loss of Hearing Loss of Two or more Hands or Feet Loss of Life Loss of Thumb &Index Finger Loss of Sight Loss of Hearing Loss of Speech Loss of oneHand or Foot Loss of Sight INSURANCE DISMEMBERMENT DEATH & ACCIDENTAL GROUP SUM PRINCIPAL MAXIMUM (as defined by thepolicy) Loss

(one eye) (both eyes) (both ears) applies for theCovered Person. Person isentitled. This amount willnotexceed thePrincipal Sumwhich Accident, We willonlypay oneamount, thelargest to whichtheCovered theCoveredIf Person sustainsmore thanonesuchLoss astheresult ofone the percentage of the Principal Sum set opposite the Loss in the table below. from such Accident,Injury Certificate, results in Loss listed below, We willpay within1-yearIf from the date ofAccident, covered by thePolicy andthe to age70aswell astheirenrolled dependent children. chosen to enroll themselves Plus Plan intheSuperGap optionandtheirenrolled Spouseup Available to membersoftheUnited allactive BusinessAssociation, ages18-79whohave Group Policy and Certificate ofInsurance andonpages 45-46ofthisguide. *Please make sure to read thefullterms, definitions, limitations, andexclusions in your (same hand) (both

ears) $5,000 WE PAY: WE PAY: WE PAY: WE PAY: WE PAY: WE PAY: WE PAY: WE PAY: WE PAY: % of Principal Sum 100% 100% 100% 100%

25% 50% 50% 50% 50% “In 2018, the U.S. experienced 167,127 preventable deaths, 46.5 million injuries, and $1,059.9 billion in costs.”1

In 2018, there was a total of 46,500,000 preventable medically consulted injuries in the United States. 27.1% occurred in public, 9.2% by motor vehicle, 18.7% were work related, 0.4% were work / motor vehicle duplications and 53.8% occurred in the home.2

1 National Safety Council. (2018). Injury Facts®. 2018 Edition. Itasca, IL. https://injuryfacts.nsc.org 2National Safety Council. (2018). Injury Facts® . 2018 Edition. Itasca, IL. https://injuryfacts.nsc.org/all-injuries/overview/

25 GROUP ACCIDENT INSURANCE 26 (as defined by theCertificate of Insurance) ADDITIONAL DETAILS OF ACCIDENT MEDICAL EXPENSEINSURANCE DEDUCTIBLE BENEFIT PERIOD LOSS PERIOD Group Policy andCertificate ofInsurance andonpages45-46ofthisguide. *Please make sure to read thefullterms, definitions, limitations, andexclusions in your MAXIMUM BENEFIT EXPENSE ANNUAL ACCIDENT MEDICAL INSURANCE EXPENSE MEDICAL ACCIDENT GROUP Benefits and is subject Benefits.to the specific maximums shown Schedule of andis subject onthe Benefits of Benefits.Schedule The Insurancetotal ofall medical benefits payable of is Schedule of under theshown inthe Certificate the Benefit Benefits. statedSchedule of Period onthe ThefirstExpensemustbe incurred withinthetime frame shown onthe be incurred solelyfor thetreatment ofacoveredInsurance whiletheperson is insured of orduring undertheCertificate injury Care Plan. The Covered Person must beunderthecare ofaPhysician whentheEligible Expensesare incurred. The Expensemust Expenses payable by any otherHealth Care Plan, regardless ofany Coordination provision of Benefits contained in suchHealth We will pay the Eligible Expenses incurred, to Amount, any subject Benefit applicable Deductible Period, that are in excess of to theCovered aninjury If Person results Eligible Expensesfor ofBenefits, inhis/herincurring intheSchedule any oftheservices (First Covered Expenses) to age70aswell astheirenrolled dependent children. chosen to enroll themselves Plus Plan intheSuperGap optionandtheirenrolled Spouseup Available to membersoftheUnited allactive BusinessAssociation, ages18-79whohave result directly, andfrom noothercause, from aCovered Accident. These We willpay Accident ExpenseBenefits Medical for Covered Expensesthat and Customary Charges.and Customary No benefitswillbepaid for any expenses incurred that are in excess of Usual 3. 2. 1. Accident are ExpenseBenefits Medical onlypayable: ofBenefits.and intheSchedule Benefit Maximumsandother orlimitsshownPeriods,Benefit terms below Deductibles, benefits areto the Co-Payment, subject Coinsurance Factors, Accident. For Eligible Expensesincurred within365days thedate after oftheCovered the Covered Person; For Eligible Expensesincurred by Necessary oronbehalfof thoseMedically For has been met; UsualCharges and Customary incurred the Deductible after 90 days occurs to prior theExpiration Date andare $25,000 Accident orInjury 1 Year from thedate oftheCovered after theCovered after Accident orInjury

is Medically Necessary.is Medically $100 , provided the injury , provided theinjury HOW TO FILE A GROUP ACCIDENT CLAIM

United Business Association Claims Unit Co-ordinated Benefit Plans Po Box 23802 Tampa, FL 33623 Phone: 877.442.7029 Email: [email protected] Online Claims Look-up: CBPConnect.com

For Claim forms, go to: ubamembers.com/claimforms.html

BENEFITS ARE NOT PAYABLE FOR LOSS DUE TO SICKNESS. THE CERTIFICATE OF INSURANCE PAYS BENEFITS FOR SPECIFIC LOSSES FROM ACCIDENTS ONLY.

27 We will pay the Daily Hospital Confinement Benefit shown in the schedule of benefits if a Covered Person is Hospital Confined as an inpatient and all of DAILY the following conditions are met: HOSPITAL • The Hospital stay is Medically Necessary and the direct result, from no CONFINEMENT other causes, of injuries or illness sustained in a Covered Accident or Sickness; and BENEFIT • Confinement is at the direction and under the care of a Physician; and • While the coverage is in effect.

DAILY HOSPITAL $500 per day CONFINEMENT BENEFIT AMOUNT For days 1-3 for Hospital Confinement GROUP HOSPITAL FIXED INDEMNITY INSURANCE FIXED INDEMNITY HOSPITAL GROUP occurring in a Policy Period

Benefit payments will end on the first of the following dates: END OF • The date the Hospital Stay ends; or BENEFIT • The date the Covered Person dies; or PAYMENTS • The date of the Maximum Benefit for this benefit is payable; or • The date insurance under the Policy ends.

We will pay the Daily Ambulance Benefit shown in the Schedule of Benefits: IN THE $50 for 1 day subject to the following conditions: DISTRICT OF • if the Covered Person requires ambulance services due to a Covered COLUMBIA: Accident or Sickness. The ambulance services provided must be for transportation from the scene of a Covered Accident to the nearest hospital that is able to provide appropriate care, or in the event of a Covered Sickness, the Medically Necessary transportation to a Hospital.

“Hospital Stay or Hospital Confinement” as defined by the Certificate of Insurance: Means a Medically Necessary overnight confinement in a Hospital when room and board and general nursing care are provided for which a per diem charge is made by the Hospital.

*Please make sure to read the full terms, definitions, limitations, and exclusions in your Group Policy and Certificate of Insurance and on pages 47-48 of this guide. 28 In 2018, there were a little over 36 million total admissions to Registered Hospitals in the United States.2

Stats taken from: 2American Hospital Association (AHA) Hospital Statistics is published annually by Health Forum, an affiliate of the American Hospital Association. Fast Facts on US Hospitals 2020 based on the 2018 AHA Annual Survey. https://www.aha.org/statistics/fast-facts-us-hospitals 29 HOSPITAL FIXED INDEMNITY INSURANCE 30 47-48 ofthisguide. exclusions inyour Group Policy andCertificate ofInsurance andonpages *Please make sure to read thefullterms, definitions, limitations, and BENEFIT AMOUNT OFFICE VISITS DAILY PHYSICIAN SERVICES WELLNESS COVERED BENEFIT & WELLNESS OFFICE VISITS PHYSICIAN DAILY

Up to of1day aMaximum perPlan Year for Necessary Medically • • Covered Wellness Include: Services of, asinglePhysician thecourse during ofonevisit. be covered onlyto theextent theyare provided by, orunderthesupervision Visits for anannualroutine care. examination orwell-child will These services treatment, addition to Necessary Medically In We will also cover Wellness advice ofaCovered Accident orSickness. or urgent care center andreceives treatment, Necessary care Medically or Office Visitsifa Covered Personvisitsa Physician’s office, Hospitalclinic, We willpayBenefits thebenefitshownSchedule of inthe for Physician’s Immunizations asprovided ofhealthregulation.Immunizations by department andphysicalA history examination; Visits andanadditional1day for other Wellness Visits. $125 perday HOSPITAL FIXED INDEMNITY INSURANCE We will pay the benefit shown in the Schedule of Benefits for Outpatient DAILY Diagnostic X-ray, Radiology or Imaging services if the following conditions are met: OUTPATIENT DIAGNOSTIC 1. A Covered Person is not confined in a Hospital; and RADIOLOGY & 2. The Diagnostic X-Rays are ordered by a Physician and performed by an appropriately licensed technician. X-RAY BENEFITS “Radiology Tests” are the scientific discipline of medical imaging using ionizing radiation, radionuclides, nuclear magnetic resonance, and ultrasound.

DAILY OUTPATIENT $75 per day DIAGNOSTIC RADIOLOGY & X-RAY BENEFIT AMOUNT Up to a Maximum of 1 day per Policy Period for Medically Necessary visits and an additional 1 day for other Wellness Visits

In addition to Medically Necessary treatment, We will also cover Wellness COVERED care in the absence of Injury or Sickness, for Outpatient Diagnostic X-Ray WELLNESS services to the extent that they are provided by, or under the supervision of, SERVICES a single technician during the course of one visit and are in accordance with accepted medical industry standards.

RADIATION Daily Outpatient Diagnostic Radiology & X-Ray Benefits does not include THERAPY Radiation Therapy.

*Please make sure to read the full terms, definitions, limitations, and exclusions in your Group Policy and Certificate of Insurance and on pages 47-48 of this guide.

31 HOSPITAL FIXED INDEMNITY INSURANCE 32 47-48 ofthisguide. exclusions inyour Group Policy andCertificate ofInsurance andonpages *Please make sure to read thefullterms, definitions, limitations, and BENEFIT AMOUNT LABORATORY TESTS DIAGNOSTIC DAILY OUTPATIENT TESTS BENEFIT LABORATORY DIAGNOSTIC OUTPATIENT DAILY SERVICES WELLNESS COVERED

Necessary visitsandanadditional1day forNecessary other Wellness Visits course ofonevisit. provided by, of, orunder the supervision a single technician the during care for Outpatient Diagnostic Laboratory Tests to theextent that theyare treatment, addition to Necessary Medically In We will also cover Wellness establish thenature ofacondition ordisease. quantify one or more significant substances, evaluate organ or functions, tests”“Laboratory are procedures that are intended to identify, detect, or 2. 1. Laboratory Tests ifthefollowing conditions are met: We will pay the Benefitsbenefit shownSchedule of in the Outpatient for Up to of1day aMaximum perPolicy Period for Medically appropriately licensed technician. testsThe are Laboratory ordered by a Physician by an and performed A Covered Person isnotconfined inaHospital;and $75 perday 33 GROUP HOSPITAL FIXED INDEMNITY INSURANCE 34 pages 47-48ofthisguide. and Certificate of Insurance and on exclusions inyour Group Policy terms, definitions, limitations, and *Please make sure to read the full BENEFIT AMOUNT ROOM VISITS DAILY EMERGENCY EMERGENCY OF MEDICAL DEFINITION SICKNESS ACCIDENT & BENEFIT FOR ROOM VISITS EMERGENCY DAILY which fulfillstheabove conditions. Treatment orInjury willbepaidonlyfor for Emergency Sickness Medical • • • • cause: reasonably that failure expect to receive immediate medicalattention would person possessing an average of health and medicine would knowledge (including severe pain)that withoutimmediate medicalcare aprudent lay one whichmanifests itselfby acute symptoms whichare sufficiently severe medical treatment at thenearest available facility. The condition mustbe for which the Covered or Injury a Sickness PersonMeans seeks immediate outpatient basis. isnotaclinicorPhysician’s Room An Emergency office. is equippedandstaffed to give peopleemergency room treatment onan Room”“Emergency meansatrauma center, orspecialarea inaHospitalthat astheresultfor Emergency ofanAccident aMedical orSickness. Room Visits ifaCovered Person requires room Hospitalemergency treatment We will pay the benefit shown in the schedule of benefits for Emergency A body organ or part would damaged. beseriously A bodyorgan orpart Covered Person’s would impaired; beseriously bodilyfunctions or disfigurementSerious ofthe Covered Person; woman Child; orherunborn torespect apregnant woman, jeopardy serious to thehealthof Covered Person’s life orhealthwould jeopardy, beinserious or, with Up to of10days aMaximum perPolicy Period $500 perday for Accident &Sickness HOW TO FILE A GROUP HOSPITAL FIXED INDEMNITY (ER) CLAIM

United Business Association Claims Unit Co-ordinated Benefit Plans Po Box 23802 Tampa, FL 33623 Phone: 877.442.7029 Email: [email protected] Online Claims Look-up: CBPConnect.com

For Claim forms, go to: ubamembers.com/claimforms.html

Claims for benefits shall be administered based on the Certificate of Insurance. Benefits are subject to the definitions, limitations, exclusions and other provisions within the Group Policy Certificate of Insurance. Group Hospital Fixed Indemnity Insurance Daily Hospital Confinement Benefit and Daily Emergency Room Visits for Accident and Sickness Benefit are available to all active members of the United Business Association, ages 18-79, who have chosen to enroll themselves in the Super Gap Plus Plan option and their enrolled spouse up to age 70 as well as their dependent children.

35 Benefits are paid on first diagnosis, as a lump sum payment, not paid based on actual expenses incurred and only if the Covered Critical Illness occurs BENEFITS after the Effective Date of Coverage for that Covered Person and while the Covered Person’s coverage under this Certificate of Insurance is in force. Please see policy for complete plan details.

MAXIMUM $25,000 LIFETIME

CRITICAL ILLNESS BENEFIT RIDER ILLNESS BENEFIT CRITICAL BENEFIT $2,500 (in the first year) $25,000 (after the first year) AMOUNT

COVERED CRITICAL ILLNESSES % of Lifetime Benefit Amount (as defined by the policy) (to be paid - lump sum only)

*Please make sure to read the full definition of covered critical illnesses in your Certificate Rider and also on page 39 of this guide. To qualify as a Covered Critical Illness, it must meet all qualifications outlined in the definition. FIRST YEAR AFTER FIRST YEAR

HEART-ATTACK WE PAY: 10% 100%

STROKE WE PAY: 10% 100%

INVASIVE CANCER WE PAY: 10% 100%

• Coverage is available to active members of the Association ages 18-64 COVERAGE and is available only to Covered Member and their eligible spouse. ELIGIBILITY • Coverage ends when the covered member turns 65. • This coverage is not available to dependent children.

Claims for benefits shall be administered based on the Certificate of Insurance. We pay a Covered Critical Illness only one time, regardless of the subsequent occurrence of the same or different Covered Critical Illness for that Covered Person. Once the benefit is paid, coverage for that Covered Person under the Certificate of Insurance terminates. Carefully read your Certificate of Insurance and Critical Illness Rider to view full definitions, limitations, exclusions and terms of coverage.

*Please make sure to read the full terms, definitions, limitations, and exclusions in 36 your Group Policy and Certificate Rider and on pages 39 & 49 of this guide. EXAMPLE OF HOW CRITICAL ILLNESS BENEFIT WORKS

Rosa’s family has a history of heart disease. Rosa was concerned for the future welfare of her family upon the event of treatment if or when she had a heart-attack for the first time. Rosa has a comprehensive medical insurance plan but knows that she still is liable for some out-of-pocket expenses like deductibles, coinsurance, and out-of- network costs. So with some financial exposure possible, Rosa and her husband John looked at a Critical Illness Plan to help offset some of these out-of-pocket costs.

1st Occurrence Happens: Our Critical Illness Insurance would provide Rosa1 The unexpected happened and Rosa was rushed to Diagnosis occurred in 1st year from effective date: the hospital after having a heart-attack for the first Rosa would receive benefit amount of $2,500. time. Diagnosis occurred after 1st year from effective date: Received Care & Filing Claim: Rosa would receive benefit amount of $25,000. Rosa received the care she needed and began to recover. Rosa went to UBAMembers.com site and downloaded the Crum CI Claim Form. She filled it out and sent it off to the insurance company. The insurance company verifies the diagnosis and claim. 37 Approximately every 40 seconds, an American will have a heart attack .2

38 COVERED CRITICAL ILLNESS DEFINITIONS AS DEFINED BY THE CERTIFICATE OF INSURANCE

HEART-ATTACK STROKE An acute myocardial infarction resulting in An acute cerebrovascular accident producing the death of a portion of the heart muscle neurological impairment and resulting in (myocardium) due to a blockage of one or more paralysis or other measurable objective of the coronary arteries and resulting in the loss neurological deficit persisting for at least thirty of normal function of the heart. (30) days. This definition of Stroke shall specifically exclude INVASIVE CANCER transient ischemic attack (mini-stroke), head injury, chronic cerebrovascular insufficiency Includes only those types of cancer manifested and reversible ischemic neurological deficits. by the presence of a malignant tumor, characterized by the uncontrolled growth and spread of malignant cells that invade tissue, blood or the lymphatic system. As used herein, Leukemia and Hodgkin’s Disease (except Stage 1 Hodgkin’s Disease) shall be considered Invasive Cancer. Does not include : It is estimated there 1) skin cancer or melanoma that is not invasive; will be 1,800,000 new 2) All tumors of prostate unless the Gleason cancer cases in 2020.3 score is greater than 6 or having progressed to at least clinical TNM classification T2 N0 M0; 3) Cancer in situ; 4) Carcinoid of the appendix; 5) Stage 0 transitional carcinoma of the urinary bladder; or 6) Any other pre-malignant lesions, benign tumors, or polyps.

Stats taken from: 2https://www.cdc.gov/heartdisease/facts.htm | Fryar CD, Chen T-C, Li X. Prevalence of uncontrolled risk factors for cardiovascular disease: United States, 1999–2010 pdf icon[PDF-494K]. NCHS data brief, no. 103. Hyattsville, MD: National Center for Health Statistics; 2012. Accessed May 9, 2019. Stats from: 3American Cancer Society. Cancer Facts & Figures 2020. Downloaded at https://www.cancer.org. 39 CRITICAL ILLNESS REQUIREMENTS 40 Clinical Diagnosis ofInvasive Cancer willbeaccepted asevidence that Invasive Cancer exists whena a study of the histocytologic architecture or pattern tumor, of the suspected tissue, and/or specimen. from thehemicsystem. Suchdiagnosis shallbebasedsolelyontheaccepted ofmalignancy, criteria after osteopathic pathology andmustbebasedonmicroscopic examination offixed tissuesorpreparations Invasive Cancer mustbediagnosed by aPhysician pathologicalto practice anatomy certified or Invasive Cancer The diagnosis ofaStroke mustbemadeby inNeurology. aPhysician board-certified Stroke Established (old)Myocardial isexcluded. Infarction 2. 1. on bothof: The diagnosis mustbemadeby ofaHeart-Attack in aPhysicianCardiology andbased board-certified Heart-Attack We may require at ourexpense anadditionalexamination by aPhysician ofourchoice. by clinical,documentation supported radiological, histological, evidence of the condition. or laboratory We adiagnosis inwriting of conditions mustbefurnished by aPhysician. This diagnosis mustinclude REQUIREMENTS OF DIAGNOSIS 2. 1. Covered Person examined by a Physician choosing at expense. ofOur Our to Condition, be a Pre-Existing no benefit amount ispayable for that listed condition. We may have the Effective Date.If the Covered Person isDiagnosed witha condition listedrider that inthisisdetermined is excluded from coverage for of12months period following theCovered Person’s Rider Illness Critical within the12month before period theCovered Person’s Effective Rider Date. A Condition Pre-Existing aconditionMeans for whichmedicaladvice, Diagnosis, care ortreatment was recommended orreceived PRE-EXISTING CONDITIONS Clinical Diagnosis ofInvasive Cancer andtheCovered Person receives treatment for Invasive Cancer. Pathological Diagnosis cannot be made, provided the medical evidence substantially documents the diagnosis of a heart attack. diagnosis ofaheart measurementSerial ofcardiac showing biomarkers apattern andto alevel consistent witha and attack; New clinicalpresentation and/orelectrocardiographic changesconsistent withanevolving heart The LifetimeBenefit Certificate Maximum for each Covered Insured is $5,000 Coverage for ceases at Illness Age Critical 65. HOW TO FILE A CRITICAL ILLNESS BENEFIT CLAIM

United Business Association Claims Unit Co-ordinated Benefit Plans Po Box 23802 Tampa, FL 33623 Phone: 877.442.7029 Email: [email protected] Online Claims Look-up: CBPConnect.com

For Claim forms, go to: ubamembers.com/claimforms.html

Claims for benefits shall be administered based on the Group Policy and Certificate Rider. Benefits are subject to the definitions, limitations, exclusions and other provisions within the Group Policy and Certificate Rider. For more information and complete details of the terms, conditions, limitations, definitions of covered critical illnesses and exclusions of coverage, please refer to the Certificate of Insurance.

41 GROUP TERM LIFE INSURANCE 42 meet theageandallrequirements listed inthePolicy Certificate. iseligibleiflisted EnrollmentSpouse ontheMembership Application orlater added, recorded, and andacknowledged by theAssociation BENEFIT MAXIMUM SUM PRINCIPAL BENEFIT AVAILABILITY STATE TERM LIFE *Please make sure to read thefull terms, definitions, limitations, and exclusions in your Certificate. Group Term Life Insurance isnotavailable inyour plan. you MaxPlan*If are andare ontheGap aMember notinoneofthestates listed above, Illinois Georgia Florida California Arizona Arkansas Alabama Group Term Life Insurance is Company. Term by Investors Life Insurance Life isunderwritten Heritage Insurance that Covered InsuredundertheCertificate terminates. Coverage for Group isalumpsumbenefit. It for andtheireligible anInsured spousewillendat Member age65. issued andany certificates, amendments,riders orendorsements. conditions ofthisinsurance willbeinaccordance withtheGroup Policy United BusinessAssociation. willbepayable Benefits andallother and term will become effective upon your effective date dueswiththe and collected upon receipt ofdue Benefits to Beneficiary proof ofdeath.your Coverage will pay Life theamount ofMember Insurance shown of intheSchedule Association andtheireligible spouses Coverage isavailable to membersoftheUnited allactive Business For &Eligible Member SpouseOnly Coverage Endsat age 65 New Mexico Nebraska Mississippi Missouri Michigan Kentucky Indiana $10,000 ONLY available inthefollowing states: Once thebenefitispaid, coverage for between the agesof 18 and64 Virginia Texas Tennessee CarolinaSouth Pennsylvania Oklahoma Ohio Insurance . We HOW TO FILE A GROUP TERM LIFE INSURANCE CLAIM

United Business Association Claims Unit Investors Heritage Life Insurance Company 200 Capital Ave, Po Box 717 Frankfort, KY 40602-0717 Phone: 1.800.422.2011 Fax: 1.502.223.6575

For Claim forms, go to: ubamembers.com/claimforms.html

Claims for benefits shall be administered based on the Master Policy issued to the United Business Association. A copy of the Certificate is available upon request.

43 IMPORTANT LIMITATIONS & EXCLUSIONS

44 Limitations & Exclusions Group Accident Insurance

THE COVERAGE IS A LIMITED BENEFIT ACCIDENT ONLY COVERAGE. READ THE CERTIFICATE CAREFULLY. BENEFITS ARE NOT PAYABLE FOR LOSS DUE TO SICKNESS. PAYS BENEFITS FOR SPECIFIC LOSSES FROM ACCIDENTS ONLY. The Certificate of Insurance does not cover any loss resulting in whole or part from, or contributed to by, or as a natural probable consequence of any of the following even if the immediate cause of the loss is an Accidental bodily injury, unless otherwise covered under the Certificate of Insurance by Additional Benefits.

1. Suicide, self-destruction, attempted self-destruction or intentional self-inflicted injury while sane or insane. 2. War or any act of war, declared or undeclared. 3. An Accident which occurs while the Covered Person is on Active Duty Service in any Armed Forces, National Guard, military, naval or air service or organized reserve corps; 4. Injury sustained while in the service of the armed forces of any country. When the Covered Person enters the armed forces of any country, We will refund the unearned pro rata premium upon request; 5. Participation in a riot or insurrection; 6. Any Injury requiring treatment which arises out of, or in the course of fighting, brawling assault or battery. 7. Sickness, disease, bodily or mental infirmity or medical or surgical treatment thereof, bacterial or viral infection, regardless of how contracted. This does not include bacterial infection that is the natural and foreseeable result of an Accidental external bodily injury or accidental food poisoning. 8. Disease or disorder of the body or mind. 9. Mental or nervous disorders, except as specifically provided in this Policy. 10. Asphyxiation from voluntarily or involuntarily inhaling gas and not the result of the Covered Person’s job. 11. Voluntarily taking any drug or narcotic unless the drug or narcotic is prescribed by a Physician and not taken in the dosage or for the purpose as prescribed by the Covered Person’s Physician. 12. Intoxication or being under the influence of any drug or narcotic. 13. Injury caused by, contributed to or resulting from the Covered Person’s use of alcohol, illegal drugs or medicines that are not taken in the dosage or for the purpose as prescribed by the Covered Person’s Physician. 14. Driving under the influence of a controlled substance unless administered on the advice of a Physician; 15. Driving while intoxicated. “Intoxicated” will have the meaning determined by the laws in the jurisdiction of the geographical area where the loss occurs. 16. Violation or in violation or attempt to violate any duly-enacted law or regulation, or commission or attempt to commit an assault or felony, or that occurs while engaged in an illegal occupation. 17. Conditions that are not caused by a Covered Accident. 18. Covered Expenses for which the Covered Person would not be responsible in the absence of this Policy. 19. Any treatment, service or supply not specifically covered by this Policy. 20. Charges which are in excess of Usual, Reasonable and Customary charges. 21. Expenses incurred for an Accident after the Benefit Period shown in the Schedule of Benefits. 22. Regular health check ups. 23. Services or treatment rendered by a Physician, Nurse or any other person who is employed or retained by the policyholder; or an Immediate Family member of the Covered Person. 24. Injuries paid under Workers’ Compensation. Employer’s liability laws or similar occupational benefits or while engaging in activity for monetary gain from sources other than the Policyholder. 25. That part of medical expense payable by any automobile insurance policy without regard to fault. (Does not apply in any state where prohibited); 26. Treatment in any Veterans Administration or Federal Hospital, except if there is a legal obligation to pay. 27. Participation in any motorized race or speed contest. 45 Limitations & Exclusions (cont’d.) Group Accident Insurance THE COVERAGE IS A LIMITED BENEFIT ACCIDENT ONLY COVERAGE. READ THE CERTIFICATE CAREFULLY. BENEFITS ARE NOT PAYABLE FOR LOSS DUE TO SICKNESS. PAYS BENEFITS FOR SPECIFIC LOSSES FROM ACCIDENTS ONLY. 28. Heart attack, stroke, or other circulatory disease or disorder, whether or not known or diagnosed, unless the immediate cause of Loss is external trauma. 29. Treatment of a hernia whether or not caused by a Covered Accident. 30. Treatment of Osgood-Schlatter’s disease, osteochondritis, appendicitis, osteomyelitis, cardiac disease or conditions, pathological or stress fractures, congenital weakness, whether or not caused by a Covered Accident. 31. Treatment of a detached retina unless caused by an Injury suffered from a Covered Accident. 32. Pregnancy, childbirth, miscarriage, abortion or any complications of any of these conditions. 33. Damage to or loss of dentures or bridges or damage to existing orthodontic equipment, except as specifically provided in this Policy. 34. Expense incurred for treatment of temporomandibular joint (TMJ) disorders involving the installation of crowns, pontics, bridges or abutments, or the installation, maintenance or removal of orthodontic or occlusal appliances or equilibration therapy; or craniomandibular joint dysfunction and associated myofacial pain, except as specifically provided in this Policy. 35. Dental care or treatment other than care of sound, natural teeth and gums required on account of Injury resulting from an Accident while the Covered Person is covered under this Policy, and rendered within 6 months of the Accident. 36. Treatment for Blood or Blood plasma, except for charges by a Hospital for the processing or administration of blood. 37. Eyeglasses, contact lenses, hearing aids, braces, appliances, or examinations or prescriptions therefore; 38. Any Accident where the Covered Person is the operator of a motor vehicle and does not possess a current and valid motor vehicle operator’s license; 39. Travel in or upon: (a) A snowmobile; (b) A water jet ski (c) Any two or three wheeled motor vehicle, other than a motorcycle registered for on-road travel; (d) Any off-road motorized vehicle not requiring licensing as a motor vehicle; 40. Travel or flight in or on any vehicle for aerial navigation, including boarding or alighting from; i. While riding as a passenger in any Aircraft not intended or licensed for the transportation of passengers; or ii. While being used for any test or experimental purpose; or iii. While piloting, operating, learning to operate or serving as a member of the crew thereof; or iv. While traveling in any such Aircraft or device which is owned or leased by or on behalf of the Policyholder or any subsidiary or affiliate of the Policyholder, or by the Covered Person or any member of their household. v. A space craft or any craft designed for navigation above or beyond the earth’s atmosphere; or vi. An ultra light, hang-gliding, parachuting or bungee-cord jumping; Except as a fare paying passenger on a regularly scheduled commercial airline or as a passenger in a non-scheduled, private aircraft used for business or pleasure purposes. 41. Practice or play in any school or professional sports contest or competition. 42. The repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices; 43. Rest cures or custodial care; 44. Prescription medicines unless specifically provided for under this Policy. 45. Elective or Cosmetic surgery, except for reconstructive surgery on a diseased or injured part of the body; 46. Massage Therapy, Physical Therapy or Acupuncture / Acupressure Services, unless otherwise specifically allowed for in the schedule of benefits. 47. Services rendered for detection and correction by manual or mechanical means (including x-rays incidental thereto) of structural imbalance, distortion or subluxation in the human body for purposes of removing nerve interference where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column. 46 Limitations & Exclusions Group Hospital Fixed Indemnity Insurance THE COVERAGE IS A LIMITED HOSPITAL FIXED INDEMNITY POLICY. IT PAYS BENEFITS REGARDLESS OF ANY OTHER INSURANCE. THE CERTIFICATE OF INSURANCE IS NOT A MAJOR MEDICAL OR COMPREHENSIVE MEDICAL HEALTHCARE POLICY.

The Certificate of Insurance does not cover any loss resulting in whole or part from, or contributed to by, or as a natural or probable consequence of any of the following: 1. Suicide, attempted suicide or intentional self-inflicted injury while sane or insane. 2. War or any act of war, declared or undeclared. 3. While the Covered Person is on Active Duty Service in any Armed Forces, National Guard, military, naval or air service or organized reserve corps; 4. Active participation in a riot or insurrection; 5. Treatment which arises out of, or in the course of fighting, brawling, assault or battery. 6. Treatment for Mental Illness or Nervous Disorders, except as specifically provided in the Policy. 7. Treatment for Substance Abuse, except as specifically provided in the Policy. 8. Injury or Sickness caused by, contributed to or resulting from the Covered Person’s use of alcohol, illegal drugs or medicines that are not taken in the dosage of for the purpose as prescribed by the Covered Person’s Physician. 9. Violation or attempt to violate any duly-enacted law or regulation, or commission or attempt to commit an assault or felony, or that occurs while engaged in an illegal occupation. 10. Services or treatment rendered by a Physician, Nurse or any other person who is employed or retained by the Policyholder; or an Immediate Family Member of the Covered Person. 11. Treatment in any Veterans Administration or Federal Hospital, except if there is a legal obligation to pay. 12. Travel or activity outside the United States, except for a Medical Emergency. 13. Participation in any motorized race or speed contest. 14. Aggravation or re-injury of a prior injury that a Covered Person suffered prior to his or her coverage Effective Date, unless We receive a written medical release from the Covered Person’s Physician. 15. Injury to a Covered Person resulting from that Covered Person’s willful violation of the Policyholder’s rules or regulations. Willful violation includes, but is not limited to: a) working without protective clothing, helmets, gloves, etc., required by the Policyholder’s rules or regulations; or b) participating in any activity that is in violation of the Policyholder’s rules or regulations. 16. Pregnancy, except Complications of Pregnancy or childbirth unless conception occurred while coverage was in force under the Policy. 17. Elective Abortion, including complications. “Elective Abortion” means an abortion for any reason other than to preserve the life of the female upon whom the abortion is performed. 18. Experimental or Investigational drugs, services, supplies or procedure that is Experimental or Investigational at the time the procedure is done. For the purposes of this exclusion, “Experimental or Investigational” means medical services, supplies or treatments provided or performed in a special setting for research purposes, under a treatment protocol or as part of a clinical trial (Phase I, II or III). The procedure will also be considered Experimental or Investigational if the Covered Person is required to sign a consent form that indicates the proposed treatment or procedure is part of a scientific study or medical research to determine its effectiveness or safety. Medical treatment, that is not considered standard treatment by the majority of the medical community or by Medicare, Medicaid or any other government financed programs or the National Cancer Institute regarding malignancies, will be considered Experimental or Investigational. A drug, device or biological product is considered Experimental or Investigational if it does not have FDA approval or approval under an interim step in the FDA process, i.e., an investigational device exemption or an investigational new drug exemption.

47 Limitations & Exclusions (cont’d.) Group Hospital Fixed Indemnity Insurance THE COVERAGE IS A LIMITED HOSPITAL FIXED INDEMNITY POLICY. IT PAYS BENEFITS REGARDLESS OF ANY OTHER INSURANCE. THE CERTIFICATE OF INSURANCE IS NOT A MAJOR MEDICAL OR COMPREHENSIVE MEDICAL HEALTHCARE POLICY. 19. Treatment for being overweight, gastric bypass or stapling, intestinal bypass, and any related procedures, including complications. 20. Treatment or services provided by a private duty nurse, unless provided for in the Policy. 21. Treatment of a detached retina unless caused by an Injury suffered from a Covered Accident. 22. Damage to or loss of dentures or bridges or damage to existing orthodontic equipment, except as specifically provided in the Policy. 23. Treatment of temporomandibular joint (TMJ) disorders involving the installation of crowns, pontics, bridges or abutments, or the installation, maintenance or removal of orthodontic or occlusal appliances or equilibration therapy; or craniomandibular joint dysfunction and associated myofacial pain, except as specifically provided in the Policy. 24. Treatment for blood or blood plasma; 25. Routine vision care. 26. Any Accident where the Covered Person is the operator of a motor vehicle and does not posses a current and valid motor vehicle operator’s license; 27. Travel in or upon, alighting to or from, or working on or around any motorcycle or recreational vehicle including but not limited to: two- or three-wheeled motor vehicle; four-wheeled all terrain vehicle (ATV); jet ski; ski cycle; snow mobile; or riding in a rodeo according to the Policy provisions; or any off-road motorized vehicle not requiring licensing as a motor vehicle; 28. Travel or flight in or on any vehicle for aerial navigation, including boarding or alighting from; i. While riding as a passenger in any Aircraft not intended or licensed for the transportation of passengers; or ii. While being used for any test or experimental purpose; or iii. While piloting, operating, learning to operate or serving as a member of the crew thereof; or iv. While traveling in any such Aircraft or device which is owned or leased by or on behalf of the Policyholder or any subsidiary or affiliate of the Policyholder, or by the Covered Person or any member of their household. v. A space craft or any craft designed for navigation above or beyond the earth’s atmosphere; or vi. An ultra light, hang-gliding, parachuting or bungee-cord jumping; Except as a fare paying passenger on a regularly scheduled commercial airline. 29. Rest cures or custodial care; 30. Prescription Drugs unless specifically provided for under the Policy. 31. Elective or cosmetic surgery, except for reconstructive surgery on a diseases or injured part of the body; 32. Physiotherapy services.

Pre-existing Conditions Limitation Pre-existing Conditions will not be covered for a period of the first 12 months after the Covered Person’s Effective Date of coverage (applies to Hospital and Surgery benefits only). “Pre-Existing Condition” means a disease or physical condition for which medical advice or treatment was recommended or received by the Covered Person during the 12 months prior to the Covered Person’s Effective Date of Coverage. This is a brief description of coverage provided under the Certificate of Insurance and is subject to the terms, conditions, limitations and exclusions of the Certificate of Insurance. Please see the Certificate of Insurance for complete details. Coverage may vary or may not be available in all states. Group Accident Insurance and Group Hospital Fixed Indemnity Insurance are underwritten by United States Fire Insurance Company, Eatontown, NJ. The insurance described in this document provides limited benefits. Limited benefit plans are insurance products with reduced benefits intended to help supplement comprehensive health insurance plans. The insurance coverage is not an alternative to comprehensive coverage. It does not provide major medical or comprehensive medical coverage and is not designed to replace major medical insurance. Further, the insurance coverage is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act. 48 Limitations & Exclusions Critical Illness Benefit Rider

THE COVERAGE IS A LIMITED HOSPITAL FIXED INDEMNITY INSURANCE THAT INCLUDES A RIDER FOR A CRITICAL ILLNESS BENEFIT. IT PAYS BENEFITS REGARDLESS OF ANY OTHER INSURANCE. THE POLICY IS NOT A MAJOR MEDICAL OR COMPREHENSIVE MEDICAL HEALTHCARE POLICY.

In addition to the Common Exclusions listed in the Certificate of Insurance, no benefits will be paid for:

1. Benign tumors or polyps that are histological described as non-malignant, pre- malignant or non-invasive. 2. Participation in the commission or attempted commission of a felony. 3. Voluntary participation in a riot or insurrection. 4. Refusing certain types of recommended medical treatment as follows: a. A Physician has recommended treatment with angioplasty or coronary artery bypass graft for coronary artery disease, the Covered Person refuses the treatment, and the Covered Person suffers a heart-attack. b. A Physician has recommended treatment for a brain aneurysm or carotid artery stenosis, the Covered Person refuses the treatment, and the Covered Person suffers a stroke. c. A Physician has recommended a diagnostic biopsy or diagnostic / therapeutic excision of a mass or lesion suspected of being cancerous, the Covered Person refuses, and the Covered Person develops cancer. 5. Conditions that have not been Diagnosed by a Physician. 6. Conditions that were diagnosed after the benefit rider has been terminated. 7. If the Covered Person’s date of birth or age was misstated on the application and, using the correct date of birth or age, the benefit would not have become effective or would have terminated prior to Diagnosis of a listed condition. 8. Pre-existing Conditions.

PAYMENT OF BENEFITS

In addition to the policy claim provisions, payment of the benefit amount is subject to all of the following conditions:

1. The sum of the benefit amounts payable under this benefit rider and any other Critical Illness policy and Critical Illness policies issued by Us on the life of the Covered Person may not exceed $5,000.

2. Only one benefit payment is allowed during the lifetime of the Covered Person, as defined by the terms and conditions of this benefit rider. After the payment is made to the Covered Person, this benefit will terminate for that particular Covered Person only.

This is a brief description of coverage provided under the Certificate Rider and is subject to the terms, conditions, limitations and exclusions of the policy. Please see the policy and Certificate Rider for complete details. Coverage may vary or may not be available in all states. Group Accident Insurance and Group Hospital Fixed Indemnity Insurance are underwritten by United States Fire Insurance Company, Eatontown, NJ. The insurance described in this document provides limited benefits. Limited benefit plans are insurance products with reduced benefits intended to help supplement comprehensive health insurance plans. The insurance coverage is not an alternative to comprehensive coverage. It does not provide major medical or comprehensive medical coverage and is not designed to replace major medical insurance. Further, the insurance coverage is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act.

49 STATE AVAILABILITY 50 Insurance Company. by Plus of the STM Super Windsor Plan is underwritten Life InsurancePlus part Company and not United States Fire inwhichtheCriticalavailable IllinessInsuranceGap in additionalstates includingAZ&TX oftheSuper Benefit Plus Plan Gap Super isavailable separately and isavailable inadditional states. The Plus STMSuper Plan isalso Plusthe STMSuper Plan. The STMPlan isavailable onanindividual available basisandmaybe inmore states. The *Note: The state availability above Plus isfor theSTMPlan Gap andtheSuper term medical insurance duration hasended. in-force monthuntilyou anddrafted to choose cancel, every even iftheshort oftheplanwillcontinue to be Plus Planof theplan.The Gap Super portion Note: Plan Durations This STMSuper PlusPlanisavailable in: Wisconsin West Virginia CarolinaSouth Carolina North Nebraska Mississippi Michigan Kentucky Iowa Georgia Arkansas Alabama Available State Wyoming ✓ only Duration is Duration isavailable inthisstate apply to the Short Term applyto theShort Medical insurance portion not available inthisstate 6 Month Plan6 Month Duration (185 days) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ combined forconvenience 12 Month Plan 12Month Duration 11 months Only (364 days) available for not ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ into 12months Short Term Medical Insurance, Group Accident Insurance, and Group Hospital Fixed Indemnity Insurance are underwritten by the United States Fire Insurance Company, 5 Christopher Way, 2nd Floor, Eatontown, NJ 07724. C&F and Crum & Forster are registered trademarks of United States Fire Insurance Company. The Crum & Forster group of companies is rated A (Excellent) by AM Best Company 2019.

51 IMMEDIATE VISITS WHEN YOU ARE SICK OR NEED TALK THERAPY SIGNIFICANT SAVINGS ON MAINTENANCE MEDS FREE GUMMY MULTI-VITAMINS PROTECT YOUR SMILE SAVE ON RX AT PHARMACY PROTECT YOUR IDENTITY

MEMBERSHIP BENEFITS PROVIDED BY:

All Benefit Boost Services are not Insurance and are separate services from the insurance as part of this membership plan. Crum & Forster, United States Fire Insurance Company and Investors Heritage Life Insurance Company do not offer and are not affliated with the additional non-insurance Benefit Boost services and discount programs offered in connection with 52 membership in the United Business Association (UBA). By selecting the Super Gap Plus Plan, your plan includes non-insurance services with Benefit Boost. The Benefit Boost Plansm offers valuable services for those looking to seek immediate medical visits or talk therapy when you are sick or feeling down, save on maintenance medications, and to keep up a healthy lifestyle with free vitamins, dental discounts and protection against identity theft. YOUR PLAN INCLUDES BENEFIT BOOST SERVICES

PGS 54-55 mailmyprescriptions.com

PGS 56-59 MeMD - Telehealth Service (Includes Urgent Care Telehealth and Talk Therapy)

PGS 60-61 Free Gummy Multi-Vitamins

PGS 62 Aetna Dental Access® Discount Program

PGS 63 Identity Theft Program - LifeLock®

PGS 64-65 Retail Prescription Discount Card Program

PGS 66-67 Pet Prescription Discount Card Program

THE BENEFIT BOOST SERVICES PROVIDED IN THIS PLAN ARE NOT INSURANCE.

All Benefit Boost Services are not Insurance and are separate services from the insurance as part of this membership plan.

Crum & Forster, United States Fire Insurance Company and Investors Heritage Life Insurance Company do not offer and are not affliated with the additional non-insurance Benefit Boost services and discount programs offered in connection with membership in the United Business Association (UBA).

53 Pharmacist Help Desk: 1.800.964.9654

MAIL ORDER PRESCRIPTIONS - Good for Maintenance Meds mailmyprescriptions.com® is a US mail-order pharmacy headquartered in Boca Raton, FL. Our mission? Make your prescriptions affordable. How do we do this? We charge you the same amount of money our pharmacy acquires the drug for, making us the most transparent and lowest cash-priced pharmacy service in America, guaranteed. If you find a lower cash pay price on a generic prescription, we will match it*. Our prices may be cheaper than your copay, deductible, or out-of-pocket price! You can look, browse your drug prices online, or give our pharmacy staff a call for any questions. Only a valid prescription from a U.S. licensed Physician and major credit, debit FSA, or HSA is required for payment! Get free price quotes and clinical care by calling 1.800.964.9654 All of your orders ship FREE! We also guarantee** a 5-day delivery

Use the Customer Code located in your guide when you create your account online or when ordering by phone. Disclosures: mailmyprescriptions.com® is America’s first wholesale pharmacy service. We operate a 24,000 sq. ft. full-service pharmacy that is licensed and regulated by the Florida Board of Pharmacy, Drug Enforcement Agency, and other State Boards of Pharmacy. We are also LegitScript verified as a safe pharmacy website. mailmyprescriptions.com® also successfully completed the VIPPS accreditation process through the NABP®. All pricing is available online and guaranteed. Pricing is subject to change. The Program is NOT an insurance plan, a discount medical plan (“DMPO”), a Medicare / Medicaid prescription drug plan or a health insurance policy. The Program does NOT accept any type of insurance. You shall be solely responsible for any and all applicable charges and taxes related to purchases made by you through the Program. You understand and agree that the Program is NOT a health insurance plan and is NOT intended as a substitute for insurance.

This Program is subject to the Terms of Service set for at https://www.mailmyprescriptions.com/terms-of-services. Please review the HIPAA Notice (https:/www.mailmyprescriptions.com/hipaa-notice) and Privacy Notice (https://www.mailmyprescriptions.com/privacy-policy).

*Generic Price Match Guarantee subject to Terms and Conditions found at https://www.mailmyprescriptions.com/generic-price-match-guarantee/ **FREE Shipping Policy subject to Terms and Conditions found at https://www.mailmyprescriptions.com/shipping-policy

54 USE CODE: in guide when ordering

DO YOU HAVE MAINTENANCE MEDICATIONS? Save up to 90% on your maintenance medications using mailmyprescriptions.com®

Shop your drug prices online at mailmyprescriptions.com® or call to speak to a pharmacist at 1.800.964.9654

55 MeMD® makes it easy to receive medical care or talk therapy from the comfort and privacy of your own home or office. Speak with one of MeMD’s board-certified medical providers online, over the phone or by mobile app available 24 hours a day, 365 days a year. Therapy sessions can be scheduled in as few as 24 hours.

As a member of UBA with the Super Gap Plus Plan, there is $0.00 cost of visits^ for: MEDICAL CARE BEHAVIORAL HEALTH URGENT CARE TELEHEALTH TALK THERAPY

^With your Membership Plan, the cost of all medical care or behavioral health visits are paid by Healthy America and not you. Urgent Care Telehealth Services

No one wants to go to work sick or take unnecessary time out of their day. And no business owner wants sick employees spreading their illness around the workplace. Still, when employees miss work, there’s a real cost to your business, from lost productivity to the extra burden on coworkers who must pick up the slack.

What We Treat While not meant to replace primary care, telehealth is ideal for many common illnesses and minor injuries. All of the medical providers in MeMD’s national network are board-certified, credentialed in accordance with NCQA guidelines, and average over 16 years of relevant clinical experience.

Available 24/7/365, we ensure members get back to their days quickly and easily. When needed, providers e-prescribe medications* to the member’s pharmacy of choice. MeMD® treats many common health issues like:

+ ALLERGIES + FLU SYMPTOMS + SKIN INFECTIONS + BITES & STINGS + MEDICATION + SORE THROATS + BRONCHITIS REFILLS* + UTIs + DIARRHEA + SINUS SYMPTOMS + And more

MeMD® provides access to online medical consultations with physicians, nurse practitioners, and physician assistants who can write prescriptions when medically necessary and permitted by state law. MeMD® also provides access to online counseling or talk therapy with behavioral health providers; however, therapists cannot write prescriptions. MeMD® is not an online pharmacy, and medications cannot be purchased or dispensed from MeMD® directly. MeMD® is not a replacement for your primary care physician or annual doctor’s office visit. Subject to state regulations, MeMD® is available nationwide with providers licensed to practice in your state who use video and/or audio technology.

*When medically necessary, MeMD’s providers (except therapists) can submit a prescription electronically for purchase and pick-up at your local participating pharmacy; however, MeMD® providers cannot prescribe elective medications, narcotic pain relievers, or controlled substances. MeMD’s providers are each licensed by the appropriate licensing board for the state in which they are providing services and all have prescriptive authority for each of the states in which they are licensed. 56 BANISH SICK WITH JUST A CLICK! 57 Talk Therapy Every business owner has witnessed the effects of behavioral health issues in the workplace. They drag down productivity and erode company culture. If left untreated, mental health concerns can even drive up medical costs

What We Treat MeMD’s national provider network includes licensed professional counselors, licensed clinical social workers, licensed marriage and family therapists, and other equivalent licensed professionals.

MeMD’s teletherapy solution removes the barriers of traditional in-person care, providing much- needed mental health care through talk therapy in the comfort and privacy of home, or anywhere else a member chooses with access to a therapist in as few as 24 hours. MeMD’s therapists provide care and counseling for:

+ ABUSE + BIPOLAR DISORDER + PARENTING ISSUES + ADDICTION + DEPRESSION + RELATIONSHIPS + ADHD / ADD + EATING DISORDERS + TRAUMA & PTSD DON’T WAIT UNTIL YOU ARE SICK + ANXIETY & STRESS + GRIEF & LOSS + And more TO SET UP YOUR ACCOUNT

MEDICAL CARE: URGENT CARE TELEHEALTH SERVICES

How it Works: • Members logon to MeMD® to request a visit with their choice of medical provider (female, male or first available) • First-time patients are connected with a care coordinator for a quick intake and to ensure the video connection is working, if requested or required. • Then, they meet with a healthcare provider who assesses their symptoms, recommends treatment, and then e-prescribes any needed medications. • The entire process is completed in under 15 minutes. 1 • Prescriptions can be picked up locally . 1when medically necessary

BEHAVIORAL HEALTH: TALK THERAPY

How it Works: • Members seeking care can schedule a 50-minute therapy session in as few as 24 hours. • Using a phone, computer or mobile device, they connect with a provider from their desired location. • Provider and patient jointly develop a treatment plan to address the member’s specific needs with mutually agreed upon goals. • Outcome-based care is built into the program with the Behavioral Health Screen, an optional multi- dimensional assessment tool that benchmarks progress and improvement.

58 DON’T WAIT UNTIL YOU ARE SICK TO SET UP YOUR ACCOUNT Set up your account in less than 5 minutes. Be ready for when you need it. If you haven’t used a service like MeMD® before, Get a diagnosis try it once and you’ll want to use it again. and prescription2 Best yet, this telehealth service for immediate day or night. medical visits or talk therapy is FREE1 to all UBA Members with Super Gap Plus Plan. DOWNLOAD THE APP USE PLAN CODE: Located in your guide www.memd.me/app-store or go to: the link provided in your guide

1Visits are paid by Healthy America & not by you. 2When medically necessary, MeMD’s providers (except therapists) can submit a prescription electronically for purchase and pick-up at your local participating pharmacy; however, MeMD® providers cannot prescribe elective medications, narcotic pain relievers, or controlled substances. MeMD’s providers are each licensed by the appropriate licensing board for the state in which they are providing services and all have prescriptive authority for each of the states in which they are licensed. 59 STAY HEALTHY

60 FREE^ ONE-A-DAY MULTI-VITAMINS

A strong immune system helps fight many of the illnesses that occur, and can delay the aging process. Study after study shows that proper supplementation with nutrients, vitamins, and herbal remedies can help prevent many “inevitable” ailments. We will supply, free of charge, the highest quality multi-vitamins for your entire family. The vitamins will be shipped directly to your home at no cost to you. This private-label program provides the same quality vitamins as are currently found on the shelves of pharmacies, supermarkets, and other retail outlets. These one-a-day formulas are complete from A-Z. The multi-vitamins your family will receive are one of the leading brands sold by healthcare professionals.

SCAN FOR VITAMIN ORDER FORM

Multivitamin Cherry & Strawberry Gumdrops

 Dietary Supplement 180 Gummies oo  B STSM UBA BENEFITA Strategy to Boost Your Healthcare

^ Free Vitamins are paid by Healthy America To Order, Scan the code above or go to: https://form.jotformpro.com/71306387418964

61 Members can save 15% to 50%* per visit, in most instances, on services at any of the more than 161,000** available dental practice locations nationwide. Dental Services include: cleanings, X-rays, fillings, root canals and crowns. Members can also save on specialty care such as orthodontics and periodontics where available.

TO GET YOUR SAVINGS 1. Select a participating provider by calling the number in your guide or log on to the link in your guide.

2. Locate the dental network logo on the front of your membership card. Give this network name (Aetna Dental Access®) to your provider when making your appointment.

3. At your appointment, simply present your membership card BEFORE GETTING TREATMENT to be assured that the proper discount is applied.

4. Payment is due at the time of services. There are no forms to complete, and no limit to the number of visits. Provider lists and fees may change at any time.

5. If you or the providers have any questions, contact Customer Service at the number listed on your membership card.

While our provider lists are continually updated, provider status can change. We recommend that you confirm the provider you selected THIS IS NOT INSURANCE participates in the program when scheduling your appointment.

*Actual costs and savings vary by provider, service and geographical area. **As of August 2015. Sample Savings1 Dental benefit is not available to Washington or Vermont residents. Product/Service Avg. Price You Pay Savings % Saved Dental Cleaning (Adult) $114.00 $63.00 $51.00 45% LifeLock Standard™ service Dental Cleaning (Child) $83.00 $46.00 $37.00 45% Just $8.99 a month Complete X-Rays $152.00 $80.00 $72.00 47% Root Canal (Anterior) $823.00 $484.00 $339.00 41% Visit their website: https://www.lifelock.com/ Complete Upper Denture $1341.00 $959.00 $382.00 28% Call: 1.800.LIFELOCK (1.800.543.3562) 1Acutal costs and savings may vary by provider, service and geographic location. We use the average of negotiated fees from participating providers to determine the average costs, as shown on the chart. Based on Aetna Navigator information 3/20/15. Mention promo code: Located in Member Guide The discount program provides access to the Aetna Dental Access® network. This network is administered by Aetna Life Insurance Company (ALIC). Neither ALIC nor any of its affiliates offers or administers the discount program. Neither ALIC nor any of its affiliates is an affiliate, agent representative, or employee of the discount program. Dental providers are independent contractors and not 62 employees or agents of ALIC or its affiliates. ALIC does not provide dental care or treatment and is not responsible for outcomes. More Detection. More Protection. We’ll help protect your identity in our digitally-connected world. Get 20% off your first year of LifeLock membership*.

Your identity makes you unique. As a member, you can get 20% off your first year of LifeLock membership. LifeLock Standard™ service Just $8.99 a month

Visit their website: https://www.lifelock.com/ Call: 1.800.LIFELOCK (1.800.543.3562) Mention promo code: Located in Member Guide

*Terms apply. Designated trademarks and brands are the properties of their respective owners. 63 Discount Prescription Plan www.ubamembers.com Pharmacist Help Desk: 1.800.481.0605 uba Pharmacist Help Desk: MEMBER ID CARD 1.800.481.0605 Member ID: XXXXXXXXX RX Member Services: Group ID: XXXXXXXX Prescription Questions: 1.800.974.3454 BIN: XXXXXX 1.800.974.3454 PCN: XXX

This is not insurance - Discount Only. Card is valid for entire family. Process all claims electronically.

UBA Prescription Retail Discount Program RETAIL PRESCRIPTIONS - Good for Acute Meds (Antibiotics, traveling, etc)

Your nationally recognized United Business Association Prescription Discount Plan provides discounts on ALL FDA approved prescription drugs. There are no limited drug lists, no waiting periods or deductibles and your Discount Drug Card—which you will receive in the mail—is active the moment you present it to the pharmacy.

Significant Savings On average, you’ll save 15% off the cash price for Brand drugs and 40% off Generic drugs. In the event a pharmacy’s price is lower than our discounted price you will always receive the lowest price available. This plan applies to your entire family. Everyone deserves to save. All family members are eligible for this benefit. Please present your card every time you need to fill a prescription for instant savings. There are absolutely no restrictions.

Everyone Can Save Your Discount Drug Card is widely accepted at over 54,000 participating pharmacies across the United States, including all national and regional chains, pharmacy associations, as well as many of your local community pharmacies. If your community pharmacy is not enrolled, ask them to contact member services at 1-800-974-3454; we always welcome new participation.

Web Tools http://www.paramountrx.com/client/uba/home.aspx

Locate a participating pharmacy

Get your discounted pharmacy pricing

Research your drug & cost effective alternatives

64 Participating Pharmacies

Your card is accepted at over 54,000 pharmacies nationwide. If your local pharmacy is not participating please have them contact member services to obtain the proper enrollment materials. The list below shows just some of the most recognized pharmacies in the network.

Albertsons Marcs Winn Dixie Rite Aid EPIC Supervalu Costco United Longs Wegmans HY-Vee Duane Reade Sav-On Bi-Lo Osco Kroger Walmart HEB Tops Safeway A&P Meijer CVS Walgreens Giant Eagle Target Kmart

This is not insurance—discount only. Process all claims electronically. 65 Pharmacist Help Desk: 1.800.481.0605 RX Member Services: 1.800.66.0514

UBA Pet Prescription Discount Program

The United Business Association Pet Prescription Plan is your retail and online source for significant savings on all pet medications. Your first step is to simply ask your veterinarian to write you a prescription, then visit our website at www.ubamembers.com to guide you through the simple ways you can begin saving hundreds of dollars or more per year on all your pets’ medications! If you prefer you can always call our Pet RX customer service team at 1.800.866.0514 for assistance on utilizing the program.

How to Save

Because of the many different types of pet medications there are several ways you can access savings. Approximately 50% of all prescriptions that pets take are actually human drugs that can be filled at your local pharmacy.

After receiving your written prescriptions from your vet, you can visit your local pharmacy with your UBA Pet Prescription Plan Card - which you will receive in the mail - and they will assist in filling them. You can also call our service team at 1.800.866.0514 and they can provide guidance on how to go about obtaining your pets’ medications.

For pet specific medications, like Frontline and Heartgard, as well as specialty pet medications, please call our service team for pricing and ordering your pets’ meds. You can find all of this information as well as participating pharmacies, prescription prices and much more at www.ubamembers.com.

Web Tools http://www.paramountrx.com/client/ubapetmed/home.aspx

Locate a participating pharmacy

Get your discounted retail pharmacy pricing

Check pricing on pet specific medications

Research your drug & cost effective alternatives

66 Participating Pharmacies

Your card is accepted at over 54,000 pharmacies nationwide. If your local pharmacy is not participating please have them contact member services to obtain the proper enrollment materials. The list below shows just some of the most recognized pharmacies in the network.

Albertsons Marcs Winn Dixie Rite Aid EPIC Supervalu Costco United Longs Wegmans HY-Vee Duane Reade Sav-On Bi-Lo Osco Kroger Walmart HEB Tops Safeway A&P Meijer CVS Walgreens Giant Eagle Target Kmart

This is not insurance—discount only. Process all claims electronically. 67 68 Network with other UBA Members & Share Small Business Knowledge

By selecting this UBA Plan and becoming a member of the United Business Association (UBA), you will have access to advertise your small business on our networking page of ubamembers. com. Since UBA is an association made up of small business owners and employees, we have provided a service for each member to network their small business with other members on our website. Not only can we help you with the ad creation, but you can also select the category of your choosing to place the ad. Healthy America, as the exclusive marketer of the United Business Association, is driving more viewers to UBA’s website. This in turn increases the viewability of UBA’s website to more than just members. It creates the potential of your ad to reach a broader audience. Also, UBA provides helpful small business articles, videos, and links in the Knowledge section of the website along with past issues of UBA Matters newsletters.

1. SUBMIT REQUEST FOR AD PLACEMENT

2. SELECT CATEGORY OF AD

3. GET AD CREATED OR SUPPLY ONE OF YOUR OWN

4. YOUR AD WILL BE UPLOADED TO UBAMEMBERS.COM

69 WHO IS UBA United Business Association

The United Business Association (UBA) is a nationwide membership of small business owners and employees. UBA leverages our purchasing power to secure benefits and discounts that may not be otherwise available on an individual basis. With association group insurance programs, shared business knowledge, business and lifestyle benefits and services and opportunities to network, We are Better Togethersm. Your membership in the United Business Association allows you to access and enroll in association group insurance programs and to apply for short term medical insurance. Various insurance companies have issued group insurance policies to the United Business Association as the group master policyholder. Product features, additional plans and availability may vary by state.

SUPER GAP PLUS & UBA MEMBERSHIP

The Super Gap Plus Plan is only available to United Business Association members. You can view the Member Guide for UBA Membership on the Member Portal at https://members.ubaapplication.com.

*You can purchase the STM Plan as as stand-alone individual short term medical plan if you so choose but because the STM Super Plus Plan includes the Super Gap Plus Plan, which is only available to United Business Association members, the STM Super Plus Plan is only available to UBA Members.

UBA REFUND / CANCELLATION POLICY

If you are not completely satisfied with your UBA Plan,please call your Personal Member Concierge at 866.438.4274. We will be happy to issue a complete refund of membership dues within the first thirty (30) days. We want you to be 100% satisfied with your UBA benefits and services.

Note: This membership is separate from any other insurance or supplemental plan you have purchased. Please contact your agent for any plans other than a UBA Membership Plan. If you are canceling, please make sure to cancel using our cancellation phone number at 866.438.4274 or our cancellation form located at www.ubamembers.com/billing.html. Please do not cancel through your agent. Cancel directly with your Personal Member Concierge to make sure your cancellation request is handled promptly and correctly.

Note: Please be aware that premium can’t be refunded for short term medical insurance after the effective date of coverage. You can cancel the short term medical insurance at any time, however it will be cancelled at the end of the coverage month and no refund will be available. 70 NON-INSURANCE MEMBERSHIP BENEFIT & SERVICES HIGHLIGHTS

• 24-Hr Nurse Helpline • Child ID Card Services • Lab Discounts • Car Rental Discounts • Discount Hearing Service • ADP Payroll Processing • Gateway Medicard • 1800Flowers.com Discounts • Health Savings Account - HSA Bank® • Office Supplies & Furniture • Travel Assistance Plan • Hewlett (HP) Computers & Equipment • LensCrafters Vision Club • UPS Express Delivery Service • GymAmerica.com • UBA Savings Perks Program • 24-Hr Roadside Assistance • National Theme Park Discounts • TrueCar Buying Network • Business Owners Policy • Graduate Scholarship Program • Data Breach / Cyber Liability • HopTheShops.com • Tickets at Work • LegalConnect® • Choice Hotels • TravelerBonus.com

71 WE PROUDLY SUPPORT

Get a Quote for this and other UBA Plans at ubamembers.com SIGN UP Contact Your Agent Today!

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STM Super Plus Plan_Crum STM SM SampleGuide_v10.20[ah-2557] United Business Association | 409 W Vickery Blvd Fort Worth, TX 76104 | 866.438.4274 | [email protected] | ubamembers.com